This planning grant will serve to plan a randomized control trial among five research centers to test whether adolescent maxillary protraction can be a non-surgical alternative to orthognathic surgery as a treatment for a skeletal underbite in the cleft lip and palate patient population. We will compare cleft lip and palate patients treated with maxillary protraction at ages 12-14 with cleft lip and palate patients who undergo orthognathic surgery at a later age, usually ages 17-19, when jaw growth as determined by radiographic and clinical assessment, has ceased. The patients who enter the maxillary protraction protocol will be treated earlier than the surgery patients. This planning grant will test the feasibility of a randomized trial and provide the basis for a long-term study which would follow the protracted patients through their late teenage years when they would traditionally be treated with surgery in order to study the effects of late growth and treatment relapse on maxillary protraction during adolescence. PROJECT NARRATIVE: This research is designed to provide a sound evidence base for surgical and orthodontic care of children with cleft lip and palate, the most common facial birth defect. This grant will serve to plan a clinical trial among five research centers to test whether an orthopedic, non-surgical treatment can be an alternative to surgery for these patients.